Columns

A reader posed an important question in her letter to the editor in The Planet: What is it that makes persons with mental illness resist taking medication? This is one of the things that seem to perplex people in the community; and it also makes it more difficult for mentally ill persons to receive much sympathy. I will try to give a detailed answer to this enigma in this week’s column.

First of all, the author of this newspaper column, yours truly, is eminently qualified to answer this question: I have discontinued medication against medical advice on three or more occasions in my past. My reactions to medications and past motives to stop taking them are typical of those who have taken anti-psychotic medications.

One of the reasons why I tried to stop medication is that some medications induce high levels of suffering. When taking certain psychiatric medications, I have dealt with an extreme “yucky” feeling from which there is no escape. Take a bad mood or perhaps a hangover and amplify it about five hundred times and you have the “yuck” feeling of being on an anti-psychotic medication. This is one reason why some mentally ill people drink a lot of coffee and smoke a lot of cigarettes; this behavior is a vain attempt at relief.

The bad feeling induced by medications creates a motive not to take them and this motive must be countered. A person can be convinced to endure this suffering if they realize that the alternative to it is a return to the psychotic state. If the person with the illness believes that he or she can get by without medication or can “tough it out” until the delusions go away, then it is not likely that the person will cooperate with treatment.

Another reason why I stopped medication is that I didn’t want to believe that my brain has a defect. It typically takes a lot of ego strength for someone to accept that something is wrong with one’s brain. Such an acknowledgment is usually a significant blow to the self-esteem. Most people’s ability to accept their selves hinges upon believing one has no major defects. Accepting medical treatment based on a defect in the brain is a considerable admission of weakness, for many people. This is one reason why there is a motive to try to get over the problem “naturally.” People would like to believe that their brain’s natural capacities would eventually solve the problem. And this could work, I believe, for a small percentage of people who are diagnosed with schizophrenia.

The problem is, in order to find out if you are one of the people who could just get over it, you are playing Russian roulette. A person who wants to explore this question by experimenting on oneself can end up with significant brain damage from repeat episodes of psychosis, as well as the long term consequences of the delusional behavior that will take place during these episodes. There isn’t and there never will be a controlled situation in which someone is “safe” from the behavior that psychosis can bring about. There is no caretaker who can safely contain such a person. This is unfortunately why some mental hospitals physically resemble prisons. Unfortunately, it is sometimes necessary to lock up a person. Whether or not the treatment they get is humane is another issue.

I ultimately decided that it is not important whether or not my brain has a defect; what matters is how well I am able to do with the hand that has been dealt me. It’s not how good your brain is that matters, but how well you use it. I have given two important reasons for the phenomenon of noncompliance There are more reasons as well. A psychiatric consumer might have delusions produced by their illness that advise not to take the medication. (Although I have had various other delusions, I do not know how common this is.) Medication affects sex drive. It also causes weight gain, and it causes slowness. The slow reflexes can inhibit performing at jobs that require physical responsiveness. While on medication, it is much harder to be motivated to perform at a job. “Helping” professionals may misinterpret the negative effects of medications as symptoms of the illness.

Going off of medications would be fine if the person could find a way around the consequence of getting sick all over again. However, nearly every time I tried to go off medications, I became very ill very quickly. Attempting to do this is rough on the brain, and could lead to lower levels of functioning in the long term.

It is not necessary to ask, “what if” concerning stopping medications, hypothetically, when we already know the practical answer is generally that it is not doable.